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Migraine - Prophylactic Treatment
Chowdhury Debashish
Annals of Indian Academy of Neurology , 2002,
Abstract: Preventive therapy in migraine constitutes an important aspect of migraine management especially in patients who are not controlled or have significant disability despite taking drugs for acute management. In spite of te recent advances in understanding of the pathophysiology of migraine, the mechanisms of action of many preventive drugs are largely unknown. Further, these provide only about 50% reduction in frequency in about 2/3rds of migraine sufferers. Hence, risk-benefit ratio must be considered while prescribing these agents. Recent efforts to undertake large-scale meta-analysis to assess the efficacy of these agents have been rewarding and consensus guidelines have evolved. Propanolol, metoprolol, amitriptyline, sodium valproate, flunarizine and lisuride have emerged as first line drugs. The role of newer anti-convulsants and botox injections in refractory cases are being investigated. Availability, co-morbidities, medical contraindications, concomitant acute therapy and costs are important determinants for choosing a particular agent. This article reviews the guidelines to be followed in choosing the prophylactic treatment options for migraine.
Prophylactic treatment of migraine; the patient's view, a qualitative study
Frans Dekker, Arie Knuistingh Neven, Boukje Andriesse, David Kernick, Ria Reis, Michel D Ferrari, Willem JJ Assendelft
BMC Family Practice , 2012, DOI: 10.1186/1471-2296-13-13
Abstract: A qualitative focus group study in general practice in the Netherlands with twenty patients recruited from urban and rural general practices. Three focus group meetings were held with 6-7 migraine patients per group (2 female and 1 male group). All participants were migraine patients according to the IHS (International Headache Society); 9 had experience with prophylactic medication. The focus group meetings were analysed using a general thematic analysis.For patients several distinguished factors count when making a decision on prophylactic treatment. The decision of a patient on prophylactic medication is depending on experience and perspectives, grouped into five categories, namely the context of being active or passive in taking the initiative to start prophylaxis; assessing the advantages and disadvantages of prophylaxis; satisfaction with current migraine treatment; the relationship with the physician and the feeling to be heard; and previous steps taken to prevent migraine.In addition to the functional impact of migraine, the decision to start prophylaxis is based on a complex of considerations from the patient's perspective (e.g. perceived burden of migraine, expected benefits or disadvantages, interaction with relatives, colleagues and physician). Therefore, when advising migraine patients about prophylaxis, their opinions should be taken into account. Patients need to be open to advice and information and intervention have to be offered at an appropriate moment in the course of migraine.Primary care is an important setting for the management of migraine and in many countries most migraine consultations occur in this context [1]. In the Netherlands, migraine is mainly managed in primary care and 95% of prescriptions for triptans are issued in this setting [2].Prophylactic therapy is an option for patients with frequent or long-lasting migraine headaches [3-8]. The results of 6-12 months of preventive treatment are that in about 50% of patients the attack fr
Effect of Prophylactic Drugs on Vestibular Evoked Myogenic Potential in Migraine Patients
Marziyeh Moallemi,Fahimeh Hajiabolhassan,Jamileh Fatahi,Mansoureh Togha
Audiology , 2012,
Abstract: Background and Aim: In many migraine patients prophylactic drugs are effective in reducing attacks and symptoms such as vestibular complaints. Therefore, related neural pathways are probably alsoaffected. This study aimed to compare vestibular evoked myogenic potential in migraine patients under treatment with prophylactic drugs and those without any treatment.Methods: Subjects included 46 patients with migraine. They were evaluated in two groups; those under treatment with prophylactic drugs (21 subjects) and those without treatment (25 subjects). Theage range of patients was 20-60 years. The vestibular evoked myogenic potential were recorded with 500 Hz tone bursts at 95 dB nHL.Results: Mean of amplitude ratio (p=0.02), and interpeak latency values in the right ear (p=0.03) and left ear (p=0.001) were higher in patients with prophylactic therapy than the group without therapy;this difference was statistically significant. There was no statistical difference between the two groups in terms of mean of latency of p13 and n23 peaks, and absolute amplitude (p>0.05).Conclusion: Prophylactic drugs probably improve mean of main response parameters of vestibular evoked myogenic potential in migraine patients with prophylactic therapy.
"Prophylactic sodium valproate and propranolol in childhood migraine: a randomized clinical trial "
"G.R. Zamani,M. Ghofrani "
Tehran University Medical Journal , 2006,
Abstract: Background: Although many agents have been used for migraine prophylaxis, little evidence is available to support their efficacy in children. Sodium valporate is one of the drugs that has been proved effective in adults. To compare the effectiveness and safety of sodium valportate and propranolol in childhood migraine, this study was designed. Methods: A 15 months open labeled crossover clinical trial was carried out having a 4 week medication free baseline phase and a 8 week treatment phase for each drug and a 4 week wash out period before crossing over. Fifty two patients started the study and we missed 4 of them due to poor compliance. Forty eight patients (23 girl and 25 boys) were randomized to sodium valporate or propranolol(1:1 ratio) treatment group. Results: The response to treatment was evaluated on basis of frequency and severity of migraine attacks. Sixty percent of valporate treated patients and 78 precent of propranolol treated ones showed 50% or greater reduction in headache frequencies from the baseline phase. Thirthy one percent of valporate and 45 precent of propranolol treated group revealed at least one grade improvement in functional restriction. McNemar statistical analysis didn't show remarkable difference between groups concerning both frequency (κ2=2.4) and severity (κ2=3.36). No serious side effect was seen during treatment. Conclusion: Sodium valporate was generally well tolerated in this study and showed favorable efficacy in childhood migraine.
Optimizing Transmission Line Matching Circuits
S. Novak
Radioengineering , 1996,
Abstract: When designing transmission line matching circuits, there exist often overlooked, additional, not much used, degree of choice in the selection of the transmission line impedance. In this work are presented results of CAD analysis for the two element transmission line matching networks, demonstrating that selecting matching circuits transmission lines with higher impedance, than usually used 50 or 75 ohms, can in most cases substantially decrease the physical dimension of the final matching circuit. Computer program, analyzing the influence of the matching line impedance on the length of the matching elements was developed and results are presented. It appears, that it is advantageous to choose matching circuits with high characteristic impedance. This results in a reduced dimension of the matching circuits.
A Framework for Optimizing Paper Matching  [PDF]
Laurent Charlin,Richard S. Zemel,Craig Boutilier
Computer Science , 2012,
Abstract: At the heart of many scientific conferences is the problem of matching submitted papers to suitable reviewers. Arriving at a good assignment is a major and important challenge for any conference organizer. In this paper we propose a framework to optimize paper-to-reviewer assignments. Our framework uses suitability scores to measure pairwise affinity between papers and reviewers. We show how learning can be used to infer suitability scores from a small set of provided scores, thereby reducing the burden on reviewers and organizers. We frame the assignment problem as an integer program and propose several variations for the paper-to-reviewer matching domain. We also explore how learning and matching interact. Experiments on two conference data sets examine the performance of several learning methods as well as the effectiveness of the matching formulations.
Investigation of Gamma-aminobutyric acid (GABA) A receptors genes and migraine susceptibility
Francesca Fernandez, Teresa Esposito, Rod A Lea, Natalie J Colson, Alfredo Ciccodicola, Fernando Gianfrancesco, Lyn R Griffiths
BMC Medical Genetics , 2008, DOI: 10.1186/1471-2350-9-109
Abstract: We have performed an association analysis in a large population of case-controls (275 unrelated Caucasian migraineurs versus 275 controls) examining a set of 3 single nucleotide polymorphisms (SNPs) in the coding region (exons 3, 5 and 9) of the GABRE gene and also the I478F coding variant of the GABRQ gene.Our study did not show any association between the examined SNPs in our test population (P > 0.05).Although these particular GABA receptor genes did not show positive association, further studies are necessary to consider the role of other GABA receptor genes in migraine susceptibility.Migraine is a common neurological disorder with variable expression, affecting more than 12% of the general population [1]. The exact cause is unknown and there are no recognizable diagnostic pathological changes. Migraine is a neurological disorder, characterised by recurrent headache that is associated with nausea and/or vomiting, photophobia and phonophobia. The International Headache Society (IHS) has formally classified migraine into two main subtypes: migraine with aura (MA) and migraine without aura (MO) [2]. These two subtypes have substantial symptomatic overlap, but MA sufferers experience distinguishing neurological disturbances (the aura) that usually precede the headache phase of an attack.The pathogenesis and pathophysiology of migraine are poorly understood. A diverse group of variables have been implicated in the pathophysiology of migraine, in particular, the serotoninergic system, with drugs that release serotonin shown to precipitate migraine attacks [3], while drugs that interact with serotonin receptors have beneficial prophylactic and abortive effects [4]. Glutamate, which is a major excitatory neurotransmitter in the central nervous system, has also been broadly involved in migraine pathophysiology. Altered glutamate levels have been measured in migraine patients [5] and glutamate has been implicated in trigeminal activation and cortical spreading depression
Symptomatic or prophylactic treatment of weekend migraine: an open-label, nonrandomized, comparison study of frovatriptan versus naproxen sodium versus no therapy
Guidotti M, Barrilà C, Leva S, De Piazza C, Omboni S
Neuropsychiatric Disease and Treatment , 2013, DOI: http://dx.doi.org/10.2147/NDT.S39373
Abstract: omatic or prophylactic treatment of weekend migraine: an open-label, nonrandomized, comparison study of frovatriptan versus naproxen sodium versus no therapy Original Research (743) Total Article Views Authors: Guidotti M, Barrilà C, Leva S, De Piazza C, Omboni S Published Date January 2013 Volume 2013:9 Pages 81 - 85 DOI: http://dx.doi.org/10.2147/NDT.S39373 Received: 19 October 2012 Accepted: 16 November 2012 Published: 16 January 2013 Mario Guidotti,1 Caterina Barrilà,1 Serena Leva,1 Claudio De Piazza,1 Stefano Omboni2 1Department of Neurology, Valduce Hospital, Como, 2Italian Institute of Telemedicine, Varese, Italy Background: Migraine often occurs during weekends. The efficacy of frovatriptan, naproxen sodium, or no therapy for the acute or prophylactic treatment of weekend migraineurs was tested in an open-label, nonrandomized pilot study. Methods: Twenty-eight subjects (mean age 36 ± 12 years, including 18 females) suffering from migraine without aura were followed up for six consecutive weekends. No treatment was administered during the first two weekends. On the third and fourth weekends, patients were given frovatriptan 2.5 mg and on the fifth and sixth weekends naproxen sodium 500 mg. Treatment was taken on Saturday and Sunday morning, regardless of the occurrence of migraine. Efficacy was evaluated through a diary, where patients reported the severity of migraine on a scale from 0 (no migraine) to 10 (severe migraine) and use of rescue medication. Results: The migraine severity score was significantly lower with frovatriptan (4.8 [95% confidence interval (CI) 3.8–5.9]) than with naproxen sodium (5.7 [CI 5.1–6.4], P < 0.05 versus frovatriptan) or no therapy (6.6 [6.2–7.0], P < 0.01 versus frovatriptan). The difference in favor of frovatriptan was more striking in patients not taking rescue medication (frovatriptan, 1.9 [1.5–2.3]) versus naproxen sodium 3.6 [3.0–4.2], P < 0.001) and versus no therapy (5.1 [4.4–5.8], P < 0.001) and on the second day of treatment. The rate of use of rescue medication was significantly (P < 0.05) lower on frovatriptan (12.5%) than on naproxen sodium (31.3%) or no therapy (56.3%). Conclusion: This pilot study provides the first evidence of the efficacy of a second-generation triptan as symptomatic or prophylactic treatment for weekend migraine.
Symptomatic or prophylactic treatment of weekend migraine: an open-label, nonrandomized, comparison study of frovatriptan versus naproxen sodium versus no therapy
Guidotti M,Barrilà C,Leva S,De Piazza C
Neuropsychiatric Disease and Treatment , 2013,
Abstract: Mario Guidotti,1 Caterina Barrilà,1 Serena Leva,1 Claudio De Piazza,1 Stefano Omboni21Department of Neurology, Valduce Hospital, Como, 2Italian Institute of Telemedicine, Varese, ItalyBackground: Migraine often occurs during weekends. The efficacy of frovatriptan, naproxen sodium, or no therapy for the acute or prophylactic treatment of weekend migraineurs was tested in an open-label, nonrandomized pilot study.Methods: Twenty-eight subjects (mean age 36 ± 12 years, including 18 females) suffering from migraine without aura were followed up for six consecutive weekends. No treatment was administered during the first two weekends. On the third and fourth weekends, patients were given frovatriptan 2.5 mg and on the fifth and sixth weekends naproxen sodium 500 mg. Treatment was taken on Saturday and Sunday morning, regardless of the occurrence of migraine. Efficacy was evaluated through a diary, where patients reported the severity of migraine on a scale from 0 (no migraine) to 10 (severe migraine) and use of rescue medication.Results: The migraine severity score was significantly lower with frovatriptan (4.8 [95% confidence interval (CI) 3.8–5.9]) than with naproxen sodium (5.7 [CI 5.1–6.4], P < 0.05 versus frovatriptan) or no therapy (6.6 [6.2–7.0], P < 0.01 versus frovatriptan). The difference in favor of frovatriptan was more striking in patients not taking rescue medication (frovatriptan, 1.9 [1.5–2.3]) versus naproxen sodium 3.6 [3.0–4.2], P < 0.001) and versus no therapy (5.1 [4.4–5.8], P < 0.001) and on the second day of treatment. The rate of use of rescue medication was significantly (P < 0.05) lower on frovatriptan (12.5%) than on naproxen sodium (31.3%) or no therapy (56.3%).Conclusion: This pilot study provides the first evidence of the efficacy of a second-generation triptan as symptomatic or prophylactic treatment for weekend migraine.Keywords: migraine, frovatriptan, naproxen sodium, weekend
Analysis of the MTHFR C677T variant with migraine phenotypes
Annie Liu, Saraswathy Menon, Natalie J Colson, Sharon Quinlan, Hannah Cox, Madelyn Peterson, Thomas Tiang, Larisa M Haupt, Rod A Lea, Lyn R Griffiths
BMC Research Notes , 2010, DOI: 10.1186/1756-0500-3-213
Abstract: The homozygous TT genotype was significantly associated with MA (P < 0.0001) and unilateral head pain (P = 0.002). While the CT genotype was significantly associated with physical activity discomfort (P < 0.001) and stress as a migraine trigger (P = 0.002). Females with the TT genotype were significantly associated with unilateral head pain (P < 0.001) and females with the CT genotype were significantly associated with nausea (P < 0.001), osmophobia (P = 0.002), and the use of natural remedy for migraine treatment (P = 0.003). Conversely, male migraineurs with the TT genotype experienced higher incidences of bilateral head pain (63% vs 34%) and were less likely to use a natural remedy as a migraine treatment compared to female migraineurs (5% vs 20%).MTHFR genotype is associated with specific clinical variables of migraine including unilateral head pain, physical activity discomfort and stress.Migraine is a complex, multifactorial disorder that affects approximately 12% of the Caucasian population [1]. At present, there are no biochemical tests to confirm the diagnosis of migraine; with diagnosis usually achieved by matching the patient's clinical manifestations to the classifications outlined by the International Headache Society (IHS) [2]. The IHS defines two main classes of migraine: migraine with aura (MA) and migraine without aura (MO) [2]. Whilst the two subtypes have significant symptomatic overlap, individuals with MA experience a distinct phase of neurological disturbances known as an "aura", that usually precedes the headache phase of an attack [3,4].The human MTHFR gene mapped to chromosome 1p36.3 catalyses the nicotinamide adenine dinucleotide phosphate (NADPH) dependent conversion of 5, 10-methylenetetrahydrofolate (CH2-THF) to 5-methyltetrahydrofolate (CH3-THF), the principal circulatory form of folate and a cofactor for methylation of homocysteine to methionine [5,6]. An increase in circulatory homocysteine levels have been reported in patients with M
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